NEMT Standing Orders in 2027: How to Run Recurring Dialysis and Therapy Rides

A standing order turns one approval into months of rides. A dialysis rider on a Monday, Wednesday, and Friday schedule is 78 one-way legs a quarter, all at the same times, to the same door. That steady work is why owners build their week around standing orders, and why a stale one does so much damage: the same wrong time repeats on every treatment day until someone fixes it.

What a standing order is, and how much of your work it can be

A standing order is a ride approved once to repeat on a fixed schedule. Programs draw the line in different places:

Program	What qualifies
Georgia Medicaid (manual, July 1, 2026)	A trip on a set schedule, such as every Tuesday afternoon at 2:00
New York (MAS policy, effective October 1, 2020)	Recurring appointments at the same location, usually the same days and times each week, such as dialysis, chemotherapy, and methadone maintenance
Illinois fee-for-service (HFS handbook, March 11, 2024)	Trips to the same medical source for the same services more than three times a month
Delaware, Modivcare (as of September 2026)	Treatment at least three days a week for three months or more, such as dialysis, substance use treatment, chemotherapy, radiation, and medical adult day care
Louisiana (manual, July 14, 2025)	Recurring treatments and therapies such as dialysis, chemotherapy, opioid treatment programs, and wound care
Virginia fee-for-service, MTM Health (from October 1, 2026)	Services such as dialysis, chemotherapy, radiation, infusion, methadone maintenance, physical or occupational therapy, behavioral health, wound care, adult day care, and supportive employment

In some programs, standing orders are most of the work. Wisconsin’s May 2026 NEMT report counted 203,022 completed standing order legs out of 301,246 completed legs, about two of every three. The share stayed near two thirds every month from January through May 2026.

Each treatment type repeats in its own way, and that shapes how you plan it:

• Dialysis. NIDDK says in-center patients get a fixed slot, usually Monday, Wednesday, and Friday, or Tuesday, Thursday, and Saturday, and each session lasts about 4 hours. The dialysis transportation guide covers routing around chair times.
• Radiation. The National Cancer Institute says most people have external beam radiation once a day, five days a week, Monday through Friday, for a set number of weeks. Ask for the last treatment date.
• Chemotherapy. The NCI says it may run in cycles of treatment and rest, and that a doctor may change the schedule because of side effects. Expect weeks with no rides and dates that move.
• Opioid treatment programs. Clinic visits can drop as a patient is allowed more take-home doses. Under 42 CFR 8.12(i), when the program’s medical practitioner decides a patient qualifies, the methadone take-home supply can reach 7 days in the first 14 days of treatment, 14 days from day 15, and 28 days from day 31. So a daily standing order can shrink to a weekly one.

How standing orders reach your company

The broker, not the facility, usually decides which company gets a standing order. The rules differ a lot:

Program	How a standing order is assigned
Virginia, MTM Health (handbook approved August 10, 2026)	Standing orders pre-set with a designated provider go to that provider automatically. So do trips for a member with a required provider on file, or from a facility with a sole source provider.
New York (policy manual, August 25, 2023)	MAS assigns trips first by the right level of service, then by the rider’s choice among its network providers, then at its own discretion. The standing order request has a field for a preferred provider.
Louisiana (manual, July 14, 2025)	The broker assigns the least costly provider. When several meet that test, the order stays with the same provider. The broker reviews every standing order at least once a month to confirm it is still the most cost-effective choice.
Oklahoma, Modivcare SoonerRide (as of September 2026)	A facility may name a preferred provider, and Modivcare notes it, but assignment follows routing criteria that include provider compliance. No preference is guaranteed.
Delaware, Modivcare (as of September 2026)	Facilities and members have no freedom of choice of provider. A request is noted, but Modivcare may use another provider.

Read your broker agreement too. MTM Health’s standard agreement, in the January 1, 2023 version Pennsylvania posts, says all trips, recurring ones included, may be assigned or reassigned at MTM’s sole discretion (section 2.Q). It adds that a provider has no right to carry any particular person or anyone attending a particular facility. A standing order is steady work, but it is never yours to keep.

How to set up a standing order, step by step

1. Find out who pays and who files. For Medicaid rides, the broker’s form or portal is the one that counts. In New York only the medical provider or its staff may enter one, never the rider, family, or transportation company. Modivcare in Oklahoma needs a Facility Registration Form from the facility before it takes standing orders. Illinois fee-for-service is the exception: transportation providers may submit standing requests themselves, by fax or through Transdev’s PassPORT portal.
2. Allow the lead time. New York wants standing orders at least 3 business days before the start date. Modivcare in Delaware wants its form at least 3 days ahead. Illinois wants 7 business days, with the medical documentation for the level of transport.
3. Get the medical forms on file. In Illinois, one Certificate of Transportation Services (HFS 2271) covers recurring wheelchair van and service car trips from home for up to 180 days, and a change in medical need or level of transport needs a new one. Georgia’s dialysis rules require a letter of medical necessity with every stretcher standing order request. Modivcare in Delaware asks for a Statement of No Alternate Transportation from the parent or guardian when a child needs a standing order.
4. Build pickup times back from the appointment. Start with the chair time or treatment time for each day, and allow for the drive, boarding, and check-in. MTM Health in Virginia requires scheduled and recurring riders to be dropped off no later than the appointment time. See NEMT scheduling.
5. Settle the return rule for each day. Write down whether the ride home is a set time or a will-call, and who calls when the rider is ready.
6. Check the first trips on your manifest. Confirm the days, times, addresses, and level of service before the first ride.
7. Put the end date and renewal date on your calendar the day the order is approved.

The free standing order form has a field for every detail a broker asks for, plus a change log.

Rides a facility or family pays for

When a dialysis center, adult day program, or family pays you directly, your written agreement is the standing order. Write the days, times, price per ride, cancellation notice, and billing terms into it, and have both sides sign. The facility transportation agreement template and NEMT facility contracts cover the terms.

Running standing orders day to day

• Keep the same driver. MTM Health’s Virginia handbook asks for a best-faith effort to use the same driver on standing order trips when scheduling allows, and a record of when a different driver had to go.
• Never move the time on your own. Florida’s contract with its Medicaid health plans (update July 1, 2026) says pre-arranged times may not be changed by the transportation provider or driver without the rider’s permission. MAS in New York tells providers to keep to the times and addresses on every trip and to direct any change to MAS, because changes requested after the ride may not be approved.
• Treat every missed standing order ride as serious. Florida’s plans must make sure no rider with a standing order misses an appointment because of a late pickup, a missed trip, or a cancellation by the transporter, and it is measured case by case from complaints.
• Hand back early, or not at all. MTM Health in Virginia expects turnbacks at least 24 hours before the pickup. Louisiana requires a provider who cannot run a trip to tell the broker immediately so it can find another provider.
• Help riders home after treatment. NIDDK says standard hemodialysis can leave people tired or washed out for several hours. Give riders time to steady themselves, and give every bit of help their level of service includes.

Keep every standing order current: the weekly check

A standing order stays the same until someone changes it with the broker. Modivcare’s Oklahoma facility page puts it plainly: its system keeps sending the original information unless Modivcare is told about a change. If a facility or rider tells only the transportation provider, the rider risks missing the appointment when the trip goes to a different provider.

Change rules differ by program:

Program	How changes work
New York (policy manual, August 25, 2023)	Any change to trip details, such as the location or day, must be approved before the ride, or payment may be denied
Louisiana (manual, July 14, 2025)	The rider or the treating facility may change pickup and drop-off times, add recurring appointments, and change the end date. The broker must update the order and may not deny rides because of those changes.
Georgia (manual, July 1, 2026)	The broker must update or confirm each standing order every 30 days from its effective date
Delaware, Modivcare (as of September 2026)	Changes go to the Facilities Department by phone or on a new standing order form

Run the same check every week, before the next week’s manifest arrives:

1. Compare the manifest with your own list of standing order riders, day by day.
2. Call each center’s scheduler about chair time changes, new riders, discharges, and hospital stays.
3. Send every change to the broker, and ask the facility to send it too. Log the date and who approved it.
4. Check next month’s end dates, and remind the care team to renew any order ending in the next 30 days.
5. Check eligibility. Illinois makes providers verify the rider’s eligibility on the day of each trip, because approval does not guarantee payment.

Eligibility checks matter more from 2027. Under Public Law 119-21, states must renew Medicaid every 6 months for expansion adults, starting with renewals scheduled on or after January 1, 2027. A standing order rider who misses a renewal can lose coverage in the middle of an order. See Medicaid six-month renewals.

How long standing orders last

Program	Length and renewal
New York (MAS policy, October 1, 2020)	Six months from the start date. MAS sends reminders before it expires, and the medical provider renews it.
Virginia fee-for-service, MTM Health (from October 1, 2026)	Up to six months at a time
Wisconsin and Minnesota, MTM Health (as of September 2026)	Dialysis up to six months at a time, other standing orders up to three months
Illinois fee-for-service (HFS handbook, March 11, 2024)	One HFS 2271 medical necessity form can cover recurring wheelchair van and service car trips from home for up to 180 days
Georgia (manual, July 1, 2026)	The broker confirms or updates each order every 30 days from its effective date

Holidays, weather, and closures

Holidays break standing orders in two ways. The center may close or shift its schedule, and the broker’s office may be closed when the change needs to be made. Georgia lets its broker close scheduling on New Year’s Day, Memorial Day, July 4th, Labor Day, Thanksgiving Day, and Christmas Day. Transdev’s Illinois business hours exclude major holidays, and MTM Health schedules routine Minnesota trips Monday through Friday, 7 a.m. to 6 p.m. Make every holiday change before those offices close.

Which riders a holiday hits depends on the weekday. Here are the next dates for the six holidays Georgia’s broker may close for, from OPM’s federal holiday schedules. Your centers set their own holiday calendars, so get each one in writing.

Holiday	Date	Dialysis schedule it falls on
Thanksgiving Day	Thursday, November 26, 2026	Tuesday, Thursday, Saturday
Christmas Day	Friday, December 25, 2026	Monday, Wednesday, Friday
New Year’s Day	Friday, January 1, 2027	Monday, Wednesday, Friday
Memorial Day	Monday, May 31, 2027	Monday, Wednesday, Friday
Independence Day	Sunday, July 4, 2027, observed by federal offices on Monday, July 5	Sunday is not a standard dialysis day. A center closed on Monday, July 5 affects Monday, Wednesday, Friday.
Labor Day	Monday, September 6, 2027	Monday, Wednesday, Friday

Opioid treatment programs work differently. Under 42 CFR 8.12(i)(1), any patient in comprehensive treatment may get take-home doses, as ordered, for days the clinic is closed, including state and federal holidays. So a closed clinic can mean no ride at all that day, not a moved one. In New York, MAS requires you to record your own holiday closures and other availability changes in your transportation provider profile.

Bad weather needs the same routine. MAS asks providers to tell it as soon as they know weather, an accident, or something else will stop a trip. Every dialysis center must plan for emergencies, with arrangements for other facilities to take its patients and an alternate emergency phone number (42 CFR 494.62). Ask each center for both. Never leave a rider at a closed door: MAS says a rider who cannot safely get into the facility goes back to the pickup location. See the NEMT holiday schedule guide and NEMT bad weather policy.

Hospital stays, treatment changes, and center moves

Standing order riders are often sick, so gaps are normal. Indiana’s fee-for-service report for May 2026 counted 135 scheduled legs missed because the rider was in the hospital, 140 because the rider was too sick, and 21 because the rider had died.

• Hospital stays. Tell the broker the same day, and report it as a temporary change, not the end of the order. Modivcare in Oklahoma, for example, asks to be told about temporary as well as permanent changes to a standing order. Ask the family or center to call the broker when the rider is ready to restart. For the ride home from the hospital, see hospital discharge transportation.
• Treatment changes. A new chair time, an added treatment day, or a finished radiation course all need a change with the broker before the ride.
• A move to a new center. Dialysis centers may discharge a patient only for listed reasons, such as the center closing or no longer being paid for the services (42 CFR 494.180(f)). Patients get 30 days’ written notice before an involuntary discharge, except when there is an immediate threat to the health and safety of others (42 CFR 494.70(b)). Ask the social worker to tell you early, so one standing order can end and the next can start.
• A change in how the rider travels. A rider who now needs a wheelchair van or a stretcher needs a new level of service and, in Illinois, a new HFS 2271.

Billing standing order rides

One approval covers many rides, but each ride is billed on its own.

• Bill each date of service. Arizona’s fee-for-service manual (revised July 31, 2026) says dialysis trips once billed monthly must now be billed trip by trip, because date-span or bulk billing is no longer accepted. Each service date must be on the claim, with actual loaded miles backed by odometer readings.
• Use the trip ID for every trip. MTM Health’s Virginia handbook says never to carry a member without the unique trip ID it assigns.
• Match the approval. Illinois makes providers wait for the authorization notice before billing, and rejects claims that do not match the approval.
• Approval is not payment. New York’s policy manual says prior authorization does not guarantee payment, and unmet eligibility rules can still deny a claim.
• Watch the filing clock. New York wants claims within 90 days of the date of service. MTM Health in Virginia allows 6 months to submit a clean claim.

A rider on three treatments a week has 12 to 14 dialysis days a month, so one habit, such as a missing signature, can cost a whole month of claims. Check the first week’s trip records before you bill the rest. See how to bill NEMT brokers.

When a state or health plan changes brokers

Standing orders follow the payer, so a broker change moves them all at once.

• Blue Cross and Blue Shield of Texas moves its Medicaid members from Modivcare to MTM Health on October 1, 2026. Its notice of August 26, 2026 says recurring trips and trips already scheduled after that date will be run through MTM Health, with no action needed from members.
• Virginia fee-for-service. DMAS picked MTM Health through a competitive procurement to run fee-for-service rides, and its transportation site sends anyone with trips on or after October 1, 2026 to MTM. Its bulletin (effective September 15, 2026) says MTM will contact every member and facility with a standing order to review it. Facilities serving IDD waiver day programs keep scheduling and changing their own standing orders.
• Wisconsin named Verida as its next statewide vendor in a notice of intent on May 21, 2026. As of September 2026, the state had set no time frame for the switch, and members keep scheduling with MTM.

When a change is announced, contract with the new broker before its start date, send it your list of standing order riders if it asks, and check the first week’s manifest against your own list line by line. See NEMT broker transitions.

How to keep the standing orders you have

Brokers can take standing orders away, and some say so in writing.

• Service problems. MTM Health’s Virginia infraction system suspends a provider for 10 days at 8 points and takes away any assigned recurring trips. At 10 points it removes the provider from its network.
• Cost. Louisiana’s broker reviews every standing order at least monthly to confirm the assigned provider is still the most cost-effective choice.
• Compliance. Modivcare in Oklahoma assigns trips using routing criteria that include provider compliance.
• Leaving a broker. MTM Health’s standard agreement requires you to run assigned trips through a 30-day termination notice, and lets MTM recover the cost of moving any you drop (section 14.B).

The best protection is the record your standing orders build: on time every treatment day, the same driver, and changes sent before the ride. Track it weekly with the NEMT KPIs guide.